KIDNEYS FOR SALE
As the list of patients waiting for a kidney transplant grows, legal and ethical questions hound the "organ trade"
By Sunly Coo, Contributing Writer
Forty-year old Nobelito Briones shows me the long scar running down the right side of his abdomen. For him, it is a constant reminder of the folly he committed seven years ago when he went under the knife to sell his kidney. It was a difficult decision, but in the wake of a fierce typhoon that had pummeled the depressed Aplaya town in Tondo, ripping his home to pieces, and with a growing brood of more than half a dozen, he had only one choice to make. He took up his kumpare's offer to sell his organ for PhP135,000-the biggest sum of money he would ever see in his lifetime.
Kumpare Bori immediately set up Briones's extensive work-up in major hospital, but not before the latter received clearance from the hospital's ethics committee that included a social worker, a psychiatrist, a priest, and a doctor. According to Briones, the committee wanted to make sure that he understood the medical procedure and was still willing to go through with the operation. He was also asked by the priest how much he was receiving in exchange for the kidney.
Once the lab results came back-a clean bill of health and compatibility tests that reveal a good match-a transplant schedule was set. The operation proceeded smoothly, and Briones stayed at the hospital for a few days to recuperate. The organ recipient, a woman in her late twenties, was grateful to him for giving her another lease on life. But when he counted the thick wad of cash that was his payment, he was surprised to find that it came up to only PhP85,000.
Where did the fifty grand go?
The woman claimed that she had already paid Bori a downpayment before the transplant. Didn't Briones receive any?
By then, Briones had a sick feeling in his stomach and it had nothing to do with the operation. As soon as he could, he confronted Bori who, after a string of denials, finally admitted there was an initial installment. He could not give him any of it though because Bori claimed he had spent all the money.
Demanding to get what was rightfully his, Briones reported the entire incident to the local barangay. Bori was brought in for questioning, but before he could be taken to the police station, the man who made his living brokering the sale of kidneys in the Manila port area had escaped.
Seven years later
Under the relentless glare of the midday sun, it is hard to imagine that the dirt-dry Baseco district of Tondo was once waterlogged, and that rows and rows of green-painted Habitat houses stand where shanties on stilts used to be.
In Briones' scramped home, his two youngest kids in a brood of 12 gathered around vying for his attention. It is Tuesday, but he isn't diving for shellfish today. He's recovering from a brawl that ensued when one of his buyers refused to pay him for the alimango he harvested. Since the transplant, he has had to quit his job as a stevedore. The doctor recommended against heavy lifting, he says, even if it's been years now.
As for the PhP85,000, it was long gone, along with the pre-Habitat house he built which was eventually consumed by a fire.
Tondo isn't the only place where the blunt sale of kidneys happens. In Taguig, another broker pulled nearly the same stunt on a tricycle driver, who received a total of PhP65,000 in installments, far short of the PhP300,000 he was promised.
The victim went straight to the National Bureau of Investigation for help. Special investigator Joey Narciso headed a successful entrapment operation that led to a safehouse where kidney "donors" from the city and the provinces stayed in the interim before their scheduled transplant in various leading tertiary hospitals.
Several files containing handwritten receipts of money transfer, angiograms, an assortment of medical records of previous clients, and a bundle of used hospital meal coupons were uncovered. According to Narciso, these coupons were used by the kidney sellers during their work-ups and were part of the broker's credit lines at the canteens.
The broker was arrested, charged, and jailed but was later released on the ground that "a considerable lapse of time since the offer of a sum of money for the removal of the left kidney of the complainant had transpired," thus he could no longer be the subject of inquest proceedings. The removal took place in October 2006. The inquest case was filed in December of the same year, and the disposition ordering his release was issued three days later.
If he were found guilty under the Anti-Trafficking of Persons Act of 2003, also known as Republic Act 9208, he would face imprisonment of 20 years and a fine of PhP1 million to PhP2 million.
It is not illegal to sell kidneys through a third person, Narciso emphasizes, referring to a section of the act. It states that it is against the law "to recruit, hire, adopt, transport or abduct a person, by means of threat or use of force, fraud, deceit, violence, coercion, or intimidation for the purpose of removal or sale of organs of said person."
But for psychiatrist Reynaldo Lesaca, head of the National Kidney and Transplant Institute's (NKTI) Human Organ Preservation Effort (HOPE), the issue is not just a question of legality but of ethics. "Religious groups and even Muslims do not object to organ donation, but they do object to the selling. The human body is considered as a gift from God," he says, and putting a price on a body part is deemed to be immoral. "In the past, I used to say that you're no different from a prostitute when you sell your kidneys."
In fact, during a screening procedure by the NKTI's ethics committee where Lesaca sits, he turned down a prospective donor after questioning his motivation. As he suspected, the man, another Baseco resident, was selling his kidney through an agent.
But recognizing the shortage of transplantable organs, Lesaca has since then sat down and educated with "commercial donors" instead of rejecting them outright. "Kung ano na lang maitutulong," many of them would end up saying.
To discourage the frank sale of kidneys and limit the exploitation of donors, the Kidney Foundation of the Philippine (KFP) has set up a gratuity package for HOPE donors. Administrator Constancio de Leon says it includes a cash reimbursement for loss of four months' income; a PhP75,000 seed fund to start a livelihood such as sari-sari store and tricycle driving; health insurance coverage with Philippine Health Insurance Corp., where KFP pays a premium of PhP120 per month for 10 years; a PhP100,000 life insurance; and regular kidney checkups for 10 years or up to age 65. In some cases, the foundation assists the donor with a job placement. KFP is also eyeing a tie-up with Gawad Kalinga for housing benefits.
The government is not taking the black market sale of kidneys lying down either. To cut out the middleman, the Department of Health has "mandated HOPE to go national." Formerly the Cadaver Organ Retrieval Effort (CORE), HOPE is the organ-retrieval arm of the NKTI.
It is "tasked to advocate organ and tissue donation and to source out transplantable organs from deceased organ donors through its network of various government and private hospitals in the country." Lesaca says that the envisioned national HOPE, working under the DOH, will serve as "a national registry of donors and recipients," a consolidated database gathered from each transplant facility through each individual HOPE unit.
Lesaca is eager to see the program launched within the year. If all goes well, he hopes stories like those of Briones and the hapless tricycle driver will never be repeated.
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